Mental Health: Mostly Personality Disorders NCLEX Questions

A client with obsessive-compulsive personality disorder takes the nurse aside and mentions "I've observed you interacting with Mr. D. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be A. "I will be continuing to follow the care plan for Mr. D." B. "I see you are trying to control Mr. D's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "Mr. D's care is really of no concern to you or to other clients."

A. "I will be continuing to follow the care plan for Mr. D." Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.

A nurse is planning care for a group of clients on a mental health unit. The nurse notes that most of the assigned clients require interventions commonly used to treat anxiety disorders. Such antianxiety interventions would be appropriate for which clients? Select all that apply. A. A client with panic disorder B. Generalized anxiety disorder C. A client with multiple personality disorder D. A client with posttraumatic stress disorder (PTSD) E. A client with obsessive-compulsive disorder (OCD)

A. A client with panic disorder B. Generalized anxiety disorder D. A client with posttraumatic stress disorder (PTSD) E. A client with obsessive-compulsive disorder (OCD) Rationale: Multiple personality disorder is considered to be a dissociative disorder rather than an anxiety disorder. Anxiety is a characteristic of panic disorder, generalized anxiety disorder, PTSD, and OCD.

A client has been diagnosed with dependent personality disorder. Which behavior descriptions can the nurse expect to assess? A. Anxious, fearful B. Odd, eccentric C. Dramatic, emotional, erratic D. Disoriented, disorganized

A. Anxious, fearful Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. These individuals have difficulty making independent decisions and are constantly seeking reassurance. They have deeply held convictions of personal incompetence, with the fear that they cannot survive on their own. They frequently seek treatment for anxiety or mood disorders related to a loss.

A nurse assists a client with a diagnosis of obsessive-compulsive disorder (OCD) in his preparations for bedtime. One hour later the client calls the nurse and says that he is feeling anxious; he asks the nurse to sit and talk for a while. Which is the appropriate initial nursing action? A. Sit and talk with the client. B. Ask the unlicensed assistive personnel to sit with the client. C. Administer the prescribed as-needed antianxiety medication. D. Tell the client that it is time for sleep and that you will talk with him tomorrow.

A. Sit and talk with the client. Rationale: The appropriate initial nursing action is to sit and talk with the client if he is expressing anxiety. An unlicensed assistive personnel may not be able to alleviate the client's anxiety. Antianxiety medication may be necessary, but this would not be the initial appropriate nursing action. Option 4 is an inappropriate action and places the client's feelings on hold.

Which statement is descriptive of clients with personality disorders? A. They are resistant to behavioral change. B. They have an ability to tolerate frustration and pain. C. They usually seek help to change maladaptive behaviors. D. They have little difficulty forming satisfying and intimate relationships.

A. They are resistant to behavioral change. Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly.

A client with histrionic personality disorder winks at an attractive nurse and states, "You and I should be able to turn those resident physicians into jelly if you'd wear your skirts about two inches shorter." The nurse's reply should be based on the understanding that the client's use of seductive behavior is A. a response to stress. B. based on a need to dominate. C. seated in primitive rage. D. callous disregard for others.

A. a response to stress. The histrionic person is impulsive and melodramatic and may act flirtatious or provocative to get the spotlight in an attempt to reduce stress

A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of A. antisocial personality disorder. B. borderline personality disorder. C. schizotypal personality disorder. D. narcissistic personality disorder.

A. antisocial personality disorder. Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts.

A danger of working with a client who idealizes the nurse is A. becoming overinvolved and being protective and indulgent. B. becoming indecisive about planned interventions. C. developing a prejudicial, blaming orientation. D. stringent enforcement of boundaries and limits.

A. becoming overinvolved and being protective and indulgent. Finding an approach for helping clients with personality disorders who have overwhelming needs can be overwhelming for caregivers. For example, a borderline female client may briefly idealize her male nurse on the inpatient unit, telling staff and clients alike that she is "the luckiest client because she has the best nurse in the hospital." The rest of the team initially realizes that this behavior is an exaggeration, and they have a neutral response. But after days of constant dramatic praise, some members of the team may start to feel inadequate and jealous of the nurse. They begin to make critical remarks about minor events to prove that the nurse is not perfect. Open communication in staff meetings and ongoing clinical supervision are important aspects of self-care for the nurse working with these clients to maintain objectivity.

Characteristics the nurse will assess in the client with antisocial personality disorder are A. deceitfulness, impulsiveness, and lack of empathy. B. perfectionism, preoccupation with detail, and verbosity. C. avoidance of interpersonal contact and preoccupation with being criticized. D. need for others to assume responsibility for decision-making and seeks nurture.

A. deceitfulness, impulsiveness, and lack of empathy. Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.

The primary goal of milieu therapy for clients with personality disorders is A. manage the affect behavior has on the entire group. B. one-on-one therapy. C. to help the client remain uninvolved with other patients. D. a laissez faire attitude.

A. manage the affect behavior has on the entire group. The primary goal of milieu therapy is affect management in a group context

A nurse is assigned to work with a client with borderline personality disorder. The nurse will need to consider strategies for dealing with the client's A. mood shifts, impulsivity, and splitting. B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail.

A. mood shifts, impulsivity, and splitting. Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned. But they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.

A nurse is performing an assessment on a client admitted to the mental health unit. The nurse notes that the client's diagnosis is documented as obsessive-compulsive disorder. The nurse plans care knowing that the client is most likely to experience which type of compulsive behavior? A. Fears B. Actions C. Illusions D. Thoughts

B. Actions Rationale: A compulsion is a repetitive act. The client with a phobia is likely to experience repetitive fears. Illusions are characteristic of schizophrenia. An obsession is a repetitive thought.

Research has indicated that antisocial personality may be characterized by: A. social isolation. B. lack of remorse. C. learning difficulties. D. difficulty with reality testing.

B. lack of remorse. The antisocial personality exhibits a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior towards others.

A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to A. set firm limits on behavior. B. respect need for social isolation. C. encourage expression of feelings. D. involve in milieu and group activities.

B. respect need for social isolation. Schizoid personality disorder has the primary feature of emotional detachment. The person does not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization

Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude.

B. splitting. Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases.

A client with dependent personality disorder who had been living with her newly married son was admitted a week ago for treatment of depression, which began after her son suggested that she move out. Which remark by the client would the nurse evaluate as showing improvement in the client's condition? A. "My son's suggestion hurt me greatly." B. "My son is less at fault than my daughter-in-law." C. "I'm going to need help to afford to rent an apartment." D. "How will I ever live alone with no one to look after my affairs?"

C. "I'm going to need help to afford to rent an apartment." Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. Clients have a deeply held conviction of personal incompetence, with the fear that they cannot survive on their won. Self reflection on the possibility of moving into an apartment shows improvement.

A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which of the following characteristics? A. Frequent episodes of psychosis B. Constant involvement with the needs of significant others C. Inflexible and maladaptive responses to stress D. Abnormal ego functioning

C. Inflexible and maladaptive responses to stress Personality patterns persist unmodified over long periods of time. Characteristics of inflexible and maladaptive response to stress is one of these characteristics for individuals with personality disorder.

Which client with a personality disorder is most likely to be admitted to a psychiatric unit? A. Mr. A, with paranoid personality disorder who is suspicious of his neighbors B. Mr. B, with narcissistic personality disorder who is highly self-important C. Ms. C, with borderline personality disorder who is impulsive D. Mrs. D, with dependent personality disorder who clings to her husband

C. Ms. C, with borderline personality disorder who is impulsive Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times.

The priority nursing intervention for a client with borderline personality disorder is to A. protect other clients from manipulation. B. respect the client's need for social isolation. C. assess for suicidal and self-mutilating behaviors. D. provide clear, consistent limits and boundaries.

C. assess for suicidal and self-mutilating behaviors. One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.

Characteristic behaviors the nurse will assess in the narcissistic client are A. dramatic expression of emotion, being easily led. B. perfectionism and preoccupation with detail. C. grandiose, exploitive, and rage-filled behavior. D. angry, highly suspicious, aloof, withdrawn behavior.

C. grandiose, exploitive, and rage-filled behavior. Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.

Clients with personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpersonal dysfunction is A. spiritual distress. B. defensive coping. C. impaired social interaction. D. disturbed sensory perception.

C. impaired social interaction. For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.

Splitting is a process in which the client A. unconsciously represses undesirable aspects of self. B. places responsibility for his or her behavior outside the self. C. sees things as divided into "all good" or "all bad." D. evidences lack of personal boundaries.

C. sees things as divided into "all good" or "all bad." Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad.

Which behavior would be inconsistent with defining characteristics for the nursing diagnosis of ineffective coping? A. Difficulty in relationships B. High levels of anxiety C. Manipulation D. Interdependence

D. Interdependence The characteristics for the diagnosis of ineffective coping include crisis, high levels of anxiety, anger and aggression; child, elder, or spouse abuse; and difficulty in relationships and manipulation. Interdependence would not be considered a symptom for ineffective coping.

A nurse is performing an assessment on a client admitted to the mental health unit. The client tells the nurse that she cannot leave home without checking numerous times that the iron and coffee pot have been shut off. The client states that this activity makes her late for many functions and that she misses engagements on occasion because of it. The nurse would expect to note which anxiety disorder documented in the client's record? A. A phobia B. Generalized anxiety disorder C. Posttraumatic stress disorder (PTSD) D. Obsessive-compulsive disorder (OCD)

D. Obsessive-compulsive disorder (OCD) Rationale: A repetitive behavior that interferes with activities of daily living and functioning is indicative of OCD. This repetitive behavior is not associated with phobias, generalized anxiety disorder, or PTSD.

A nurse is preparing to admit a client with a diagnosis of obsessive-compulsive disorder (OCD) to the mental health unit. The nurse would expect to note which behaviors in the client? A. Suspicious and hostile B. Flexible and adaptable C. Frightened and delusional D. Rigidness in thought and inflexibility

D. Rigidness in thought and inflexibility Rationale: Rigid and inflexible behaviors are characteristic of the client with OCD. Clients with this disorder usually are not hostile unless they are prevented from engaging in the obsession or compulsion, because this behavior is what decreases the anxiety. Options 1, 2, and 3 are incorrect and are not characteristic of OCD.